EVALUATION OF A PROSPECTIVE PAYMENT SYSTEM FOR VA CONTRACT NURSING-HOMES

An evaluation of a pilot program for community nursing home care reimb ursement by Department of Veterans Affairs Medical Centers (VAMCs) war undertaken Eight VAMCs began using the Enhanced Prospective Payment S ystem (EPPS) in 1992. These sites were compared to eight customary pay ment sites in a pretest/posttest quasi-experimental design. Outcomes i ncluded access to care, administrative workload quality of care, and c ost. As expected, per diem costs were significantly higher for EPPS th an customary reimbursement patients ($106 vs. $87). However EPPS sites placed veterans more quickly (81 days vs. 113 days; p < .01) than com parison sites and reduced administrative workload associated with plac ement. EPPS sites also increased the number of Medicare-certified home s under contract (76% vs. 54%) and placed significantly more veterans who received therapy (20% vs. < 1%). Savings in hospital days more tha n offset the increased cost of nursing home placement. Because the fin dings were attributed largely to a few veterans with long lengths of h ospital stay, the early success of EPPS may diminish as the backlog of these long-stay patients decreases.